Louis Robert Broadhurst

Individual provider Active NPI Physical Therapy Assistant · Donnellson, IA

NPI 1043096324 · NPPES record last updated Sep 4, 2023

Key facts

NPI
1043096324
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapy Assistant 225200000X
Practice address
620 Park St
Donnellson, IA 52625-9628
Phone
(319) 795-6495
NPI assigned
Sep 4, 2023
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X Yes

Addresses

Primary practice location

620 Park St
Donnellson, IA 52625-9628

Mailing address

620 Park St
Donnellson, IA 52625-9628
Phone (319) 795-6495

Other names

  • Louis Robert Broadhurst Professional name

Other providers in Donnellson, IA

All providers in Donnellson, IA · Physical Therapy Assistant in Iowa

Sources for this page

Verify at the official NPI Registry.